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Pooler BD, Kim DH, Matkowskyj KA, Newton MA, Halberg RB, Grady WM, Hassan C, Pickhardt PJ. Natural History of Colorectal Polyps Undergoing Longitudinal in Vivo CT Colonography Surveillance. Radiology 2024; 310:e232078. [PMID: 38289210 PMCID: PMC10831482 DOI: 10.1148/radiol.232078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 02/01/2024]
Abstract
Background The natural history of colorectal polyps is not well characterized due to clinical standards of care and other practical constraints limiting in vivo longitudinal surveillance. Established CT colonography (CTC) clinical screening protocols allow surveillance of small (6-9 mm) polyps. Purpose To assess the natural history of colorectal polyps followed with CTC in a clinical screening program, with histopathologic correlation for resected polyps. Materials and Methods In this retrospective study, CTC was used to longitudinally monitor small colorectal polyps in asymptomatic adult patients from April 1, 2004, to August 31, 2020. All patients underwent at least two CTC examinations. Polyp growth patterns across multiple time points were analyzed, with histopathologic context for resected polyps. Regression analysis was performed to evaluate predictors of advanced histopathology. Results In this study of 475 asymptomatic adult patients (mean age, 56.9 years ± 6.7 [SD]; 263 men), 639 unique polyps (mean initial diameter, 6.3 mm; volume, 50.2 mm3) were followed for a mean of 5.1 years ± 2.9. Of these 639 polyps, 398 (62.3%) underwent resection and histopathologic evaluation, and 41 (6.4%) proved to be histopathologically advanced (adenocarcinoma, high-grade dysplasia, or villous content), including two cancers and 38 tubulovillous adenomas. Advanced polyps showed mean volume growth of +178% per year (752% per year for adenocarcinomas) compared with +33% per year for nonadvanced polyps and -3% per year for unresected, unretrieved, or resolved polyps (P < .001). In addition, 90% of histologically advanced polyps achieved a volume of 100 mm3 and/or volume growth rate of 100% per year, compared with 29% of nonadvanced and 16% of unresected or resolved polyps (P < .001). Polyp volume-to-diameter ratio was also significantly greater for advanced polyps. For polyps observed at three or more time points, most advanced polyps demonstrated an initial slower growth interval, followed by a period of more rapid growth. Conclusion Small colorectal polyps ultimately proving to be histopathologically advanced neoplasms demonstrated substantially faster growth and attained greater overall size compared with nonadvanced polyps. Clinical trial registration no. NCT00204867 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Dachman in this issue.
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Affiliation(s)
- B. Dustin Pooler
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - David H. Kim
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Kristina A. Matkowskyj
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Michael A. Newton
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Richard B. Halberg
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - William M. Grady
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Cesare Hassan
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
| | - Perry J. Pickhardt
- From the Departments of Radiology (B.D.P., D.H.K., P.J.P.), Pathology and Laboratory Medicine (K.A.M.), Biostatistics and Informatics (M.A.N.), Medicine (R.B.H.), and Oncology (R.B.H.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252; William S. Middleton Memorial Veterans Hospital and Clinics, Madison, Wis (K.A.M.); Department of Statistics, College of Letters and Science, University of Wisconsin, Madison, Wis (M.A.N.); Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Wash (W.M.G.); Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Wash (W.M.G.); Department of Biomedical Sciences, Humanitas University, Milan, Italy (C.H.); and Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy (C.H.)
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Pooler BD, Kim DH, Matkowskyj KA, Newton MA, Halberg RB, Grady WM, Hassan C, Pickhardt PJ. Growth rates and histopathological outcomes of small (6-9 mm) colorectal polyps based on CT colonography surveillance and endoscopic removal. Gut 2023; 72:2321-2328. [PMID: 37507217 PMCID: PMC10822024 DOI: 10.1136/gutjnl-2022-326970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND AIMS The natural history of small polyps is not well established and rests on limited evidence from barium enema studies decades ago. Patients with one or two small polyps (6-9 mm) at screening CT colonography (CTC) are offered CTC surveillance at 3 years but may elect immediate colonoscopy. This practice allows direct observation of the growth of subcentimetre polyps, with histopathological correlation in patients undergoing subsequent polypectomy. DESIGN Of 11 165 asymptomatic patients screened by CTC over a period of 16.4 years, 1067 had one or two 6-9 mm polyps detected (with no polyps ≥10 mm). Of these, 314 (mean age, 57.4 years; M:F, 141:173; 375 total polyps) elected immediate colonoscopic polypectomy, and 382 (mean age 57.0 years; M:F, 217:165; 481 total polyps) elected CTC surveillance over a mean of 4.7 years. Volumetric polyp growth was analysed, with histopathological correlation for resected polyps. Polyp growth and regression were defined as volume change of ±20% per year, with rapid growth defined as +100% per year (annual volume doubling). Regression analysis was performed to evaluate predictors of advanced histology, defined as the presence of cancer, high-grade dysplasia (HGD) or villous components. RESULTS Of the 314 patients who underwent immediate polypectomy, 67.8% (213/314) harboured adenomas, 2.2% (7/314) with advanced histology; no polyps contained cancer or HGD. Of 382 patients who underwent CTC surveillance, 24.9% (95/382) had polyps that grew, while 62.0% (237/382) remained stable and 13.1% (50/382) regressed in size. Of the 58.6% (224/382) CTC surveillance patients who ultimately underwent colonoscopic resection, 87.1% (195/224) harboured adenomas, 12.9% (29/224) with advanced histology. Of CTC surveillance patients with growing polyps who underwent resection, 23.2% (19/82) harboured advanced histology vs 7.0% (10/142) with stable or regressing polyps (OR: 4.0; p<0.001), with even greater risk of advanced histology in those with rapid growth (63.6%, 14/22, OR: 25.4; p<0.001). Polyp growth, but not patient age/sex or polyp morphology/location were significant predictors of advanced histology. CONCLUSION Small 6-9 mm polyps present overall low risk to patients, with polyp growth strongly associated with higher risk lesions. Most patients (75%) with small 6-9 mm polyps will see polyp stability or regression, with advanced histology seen in only 7%. The minority of patients (25%) with small polyps that do grow have a 3-fold increased risk of advanced histology.
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Affiliation(s)
- B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kristina A Matkowskyj
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- William S Middleton Memorial Veterans Hospital and Clinics, Madison, Wisconsin, USA
| | - Michael A Newton
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Statistics, College of Letters and Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Richard B Halberg
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Department of Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William M Grady
- Department of Medicine, Division of Gastroentrology, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Translational Science and Therapeutics, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Zacharias N, Lubner MG, Kim DH, Pickhardt PJ. Comparison of MiraLAX and magnesium citrate for bowel preparation at CT colonography. Abdom Radiol (NY) 2023; 48:3322-3331. [PMID: 37644134 DOI: 10.1007/s00261-023-04025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To compare MiraLAX, a hypo-osmotic lavage, and magnesium citrate (MgC), a hyper-osmotic agent for bowel preparation at CTC. METHODS 398 total screening CTC studies were included in this retrospective, single institution study. 297 underwent preparation with a double-dose MgC regimen (mean age, 61 ± 5.5 years; 142 male/155 female) and 101 with 8.3 oz (equivalent to 238 g PEG) of MiraLAX (mean age, 60 ± 9.6 years; 45 male/56 female). Oral contrast for tagging purposes was utilized in both regimens. Studies were retrospectively analyzed for residual fluid volume and attenuation by automated analysis, as well for subjective oral contrast coating of the normal colonic wall and polyps. 50 patients underwent successive CTC studies utilizing each agent (mean, 6.1 ± 1.7 years apart), allowing for intra-patient comparison. Chi-squared, Fisher's exact, McNemar, and t-tests were used for data comparison. RESULTS Residual fluid volume (as percentage of total colonic volume) and fluid density was 7.2 ± 4.2% and 713 ± 183 HU for the MgC cohort and 8.7 ± 3.8% and 1044 HU ± 274 for the MiraLAX cohort, respectively (p = 0.001 and p < 0.001, respectively). Similar results were observed for the intra-patient cohort. Colonic wall coating negatively influencing interpretation was noted in 1.7% of MgC vs. 6.9% of MiraLAX examinations (p = 0.008). Polyps were detected in 12% of all MgC vs. 16% of all MiraLAX CTCs (p = 0.29). CONCLUSION CTC bowel preparation with the hypo-osmotic MiraLAX agent appears to provide acceptable diagnostic quality that is comparable to the hyper-osmotic MgC agent, especially when factoring in patient safety and tolerance.
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Affiliation(s)
- Nicholas Zacharias
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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Pickhardt PJ. CT Colonography: The Role of Radiologist Training. Radiology 2022; 303:371-372. [PMID: 35166590 PMCID: PMC9081517 DOI: 10.1148/radiol.213148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Perry J. Pickhardt
- From the Department of Radiology, The University of Wisconsin School
of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave,
Madison, WI 53792-3252
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Min Q, Wang X, Huang B, Xu L. Web-Based Technology for Remote Viewing of Radiological Images: App Validation. J Med Internet Res 2020; 22:e16224. [PMID: 32975520 PMCID: PMC7547396 DOI: 10.2196/16224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 07/21/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Internet technologies can create advanced and rich web-based apps that allow radiologists to easily access teleradiology systems and remotely view medical images. However, each technology has its own drawbacks. It is difficult to balance the advantages and disadvantages of these internet technologies and identify an optimal solution for the development of medical imaging apps. OBJECTIVE This study aimed to compare different internet platform technologies for remotely viewing radiological images and analyze their advantages and disadvantages. METHODS Oracle Java, Adobe Flash, and HTML5 were each used to develop a comprehensive web-based medical imaging app that connected to a medical image server and provided several required functions for radiological interpretation (eg, navigation, magnification, windowing, and fly-through). Java-, Flash-, and HTML5-based medical imaging apps were tested on different operating systems over a local area network and a wide area network. Three computed tomography colonography data sets and 2 ordinary personal computers were used in the experiment. RESULTS The experimental results demonstrated that Java-, Flash-, and HTML5-based apps had the ability to provide real-time 2D functions. However, for 3D, performances differed between the 3 apps. The Java-based app had the highest frame rate of volume rendering. However, it required the longest time for surface rendering and failed to run surface rendering in macOS. The HTML5-based app had the fastest surface rendering and the highest speed for fly-through without platform dependence. Volume rendering, surface rendering, and fly-through performances of the Flash-based app were significantly worse than those of the other 2 apps. CONCLUSIONS Oracle Java, Adobe Flash, and HTML5 have individual strengths in the development of remote access medical imaging apps. However, HTML5 is a promising technology for remote viewing of radiological images and can provide excellent performance without requiring any plug-ins.
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Affiliation(s)
- Qiusha Min
- School of Educational Information Technology, Central China Normal University, Wuhan, Hubei, China
| | - Xin Wang
- School of Educational Information Technology, Central China Normal University, Wuhan, Hubei, China
| | - Bo Huang
- Department of Radiology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
| | - Liangzhou Xu
- Department of Radiology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China
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Mang T, Bräuer C, Gryspeerdt S, Scharitzer M, Ringl H, Lefere P. Electronic cleansing of tagged residue in CT colonography: what radiologists need to know. Insights Imaging 2020; 11:47. [PMID: 32170498 PMCID: PMC7070139 DOI: 10.1186/s13244-020-00848-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
CT colonography (CTC) is the radiological examination of choice for the diagnosis of colorectal neoplasia. Faecal tagging is considered a mandatory part of bowel preparation. However, the colonic mucosa, obscured by tagged residue, is not accessible to endoluminal 3D views and requires time-consuming 2D evaluation. Electronic cleansing (EC) software algorithms can overcome this limitation by digitally subtracting tagged residue from the colonic lumen. Ideally, this enables a seamless 3D endoluminal evaluation. Despite this benefit, EC is a potential source of a wide range of artefacts. Accurate EC requires proper CTC examination technique and faecal tagging. The digital subtraction process has been shown to affect the relevant morphological features of both colonic anatomy and colonic lesions, if submerged under faecal residue. This article summarises the potential effects of EC on CTC imaging, the consequences for reporting and patient management, and strategies to avoid pitfalls. Furthermore, potentially negative effects on clinical reporting and patient management are shown, and problem-solving techniques, as well as recommendations for the appropriate use of EC techniques, are presented. Radiologists using EC should be familiar with EC-related effects on polyp size and also with correct measurement techniques.
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Affiliation(s)
- Thomas Mang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
| | - Christian Bräuer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Stefaan Gryspeerdt
- Department of Radiology, AZ Delta, Bruggesteenweg 90, B-8800, Roeselare, Belgium
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Helmut Ringl
- Department of Radiology, Danube Hospital Vienna, Langobardenstrasse 122, A-1220, Wien, Austria
| | - Philippe Lefere
- Department of Radiology, AZ Delta, Bruggesteenweg 90, B-8800, Roeselare, Belgium
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A quantitative validation of segmented colon in virtual colonoscopy using image moments. Biomed J 2020; 43:74-82. [PMID: 32200958 PMCID: PMC7090282 DOI: 10.1016/j.bj.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022] Open
Abstract
Background Evaluation of segmented colon is one of the challenges in Computed Tomography Colonography (CTC). The objective of the study was to measure the segmented colon accurately using image processing techniques. Methods This was a retrospective study, and the Institutional Ethical clearance was obtained for the secondary dataset. The technique was tested on 85 CTC dataset. The CTC dataset of 100–120 kVp, 100 mA, and ST (Slice Thickness) of 1.25 and 2.5 mm were used for empirical testing. The initial results of the work appear in the conference proceedings. Post colon segmentation, three distance measurement techniques, and one volumetric overlap computation were applied in Euclidian space in which the distances were measured on MPR views of the segmented and unsegmented colons and the volumetric overlap calculation between these two volumes. Results The key finding was that the measurements on both the segmented and the unsegmented volumes remain same without much difference noticed. This was statistically proved. The results were validated quantitatively on 2D MPR images. An accuracy of 95.265±0.4551% was achieved through volumetric overlap computation. Through pairedt−test, at α=5%, statistical values were p=0.6769, and t=0.4169 which infer that there was no much significant difference. Conclusion The combination of different validation techniques was applied to check the robustness of colon segmentation method, and good results were achieved with this approach. Through quantitative validation, the results were accepted at α=5%.
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Interobserver Variation of Colonic Polyp Measurement at Computed Tomography Colonography. Can Assoc Radiol J 2019; 70:44-51. [PMID: 30691562 DOI: 10.1016/j.carj.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/14/2018] [Accepted: 09/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The concept of "advanced polyps" is well accepted and is defined as polyps ≥10 mm and/or those having a villous component and/or demonstrating areas of dysplasia. Of these parameters, computed tomography colonography (CTC) can only document size. The accepted management of CTC-detected "advanced polyps" is to recommend excision if feasible, whereas the management of "intermediate" (6-9 mm) polyps is more controversial, and interval surveillance may be acceptable. Therefore, distinction between 6-9 mm and ≥10 mm is important. METHODS Datasets containing 26 polyps originally reported as between 8-12 mm in diameter were reviewed independently by 4 CTC-accredited radiologists. Observers tabulated the largest measurement for each polyp on axial, coronal, sagittal, and endoluminal views at lung-window settings. These measurements were also compared to those determined by the computer-aided detection (CAD) software. RESULTS The interobserver reliability intra-class correlation coefficient (ICC) for sagittal projection was 0.80 ("excellent" category of Hosmer and Lemeshow [2004]), 0.71 for axial ("acceptable"), 0.69 for coronal, and 0.41 for endoluminal ("unacceptable"). The largest of sagittal/axial/coronal measurement gave the best reliability with the smallest variance (ICC = 0.80; 95% CI 0.67-0.89). For 8 of 26 polyps, at least one radiologist's measurement placed the polyp in a different category compared to a colleague. For the majority of the polyps, the CAD significantly overestimated the readings compared to the largest of the manual measurements with an average difference of 1.6 mm (P < .0001 for sagittal/axial/coronal). This resulted in 33% of polyps falling into a different category-10% were lower and 23% were higher (P < .034). CONCLUSION It is apparent that around the cutoff point of 10 mm between "advanced" and "intermediate" polyps, interobserver performance is variable.
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CT colonography screening in extracolonic cancer survivors: impact on rates of colorectal and extracolonic findings by cancer type. Abdom Radiol (NY) 2019; 44:31-40. [PMID: 30066170 DOI: 10.1007/s00261-018-1708-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the rates of colorectal and extracolonic findings at CT colonography (CTC) screening between patients with and without a personal prior history of other. METHODS Over a 160-month interval, 349 adults (mean age, 60.3 years; 67% female) with a positive history of extracolonic cancer [Ca(+)], excluding 271 patients with isolated non-melanoma skin cancers, underwent CTC screening. This study cohort was compared against 8859 controls (mean age, 57.0 years; 53% female) without a prior cancer history [Ca(-)]. Primary outcome measures included the rates of relevant colorectal (C-RADS C2-C4) and extracolonic (C-RADS E3-E4) findings at CTC. Wilcoxon rank sum test was used to test for statistical significance with post-hoc analysis by relative rate (RR). RESULTS Both colorectal (C2-C4) and extracolonic (E3-E4) findings were significantly increased in the Ca(+) group versus Ca(-) control group (p = 0.0283 and 0.0236, respectively). Positive colorectal findings were most notably increased among survivors of non-small cell lung cancer (RR 3.1), head/neck cancers (RR, 3.4), and bladder cancers (RR 2.2). The proportion of C2-C4 patients undergoing intervention in the Ca(+) cohort was not significantly different than the Ca(-). Potentially relevant extracolonic findings (E3) were increased in survivors of hematogenous malignancies (RR 2.0), while likely important extracolonic findings (E4) were increased in survivors of female gynecological malignancies (RR 3.4). CONCLUSIONS Relevant colorectal and extracolonic findings at CTC screening are increased in patients with a previous extracolonic cancer history, particularly among certain cancer subsets. These results may have important implications for choice of colorectal test in these patients.
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Regan EA, Lowe KE, Make BJ, Lynch DA, Kinney GL, Budoff MJ, Mao SS, Dyer D, Curtis JL, Bowler RP, Han MK, Beaty TH, Hokanson JE, Kern E, Humphries S, Curran-Everett D, van Beek EJR, Silverman EK, Crapo JD, Finigan JH. Identifying Smoking-Related Disease on Lung Cancer Screening CT Scans: Increasing the Value. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:233-245. [PMID: 31342730 DOI: 10.15326/jcopdf.6.3.2018.0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Lung cancer screening (LCS) via chest computed tomography (CT) scans can save lives by identifying early-stage tumors. However, most smokers die of comorbid smoking-related diseases. LCS scans contain information about smoking-related conditions that is not currently systematically assessed. Identifying these common comorbid diseases on CT could increase the value of screening with minimal impact on LCS programs. We determined the prevalence of 3 comorbid diseases from LCS eligible scans and quantified related adverse outcomes. Methods We studied COPD Genetic Epidemiology study (COPDGene®) participants (n=4078) who met criteria for LCS screening at enrollment (age > 55 years, and < 80 years, > 30 pack years smoking, current smoker or former smoker within 15 years of smoking cessation). CT scans were assessed for coronary artery calcification (CAC), emphysema, and vertebral bone density. We tracked the following clinically significant events: myocardial infarctions (MIs), strokes, pneumonia, respiratory exacerbations, and hip and vertebral fractures. Results Overall, 77% of eligible CT scans had one or more of these diagnoses identified. CAC (> 100 mg) was identified in 51% of scans, emphysema in 44%, and osteoporosis in 54%. Adverse events related to the underlying smoking-related diseases were common, with 50% of participants reporting at least one. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46%, of participants respectively. New diagnosis of disease was associated with significantly more adverse events than in participants who did not have CT diagnoses for both osteoporosis and cardiovascular risk. Conclusions Expanded analysis of LCS CT scans identified individuals with evidence of previously undiagnosed cardiovascular disease, emphysema or osteoporosis that corresponded with adverse events. LCS CT scans can potentially facilitate diagnoses of these smoking-related diseases and provide an opportunity for treatment or prevention.
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Affiliation(s)
- Elizabeth A Regan
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado.,School of Public Health, University of Colorado, Denver
| | - Katherine E Lowe
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado.,School of Public Health, University of Colorado, Denver
| | - Barry J Make
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - David A Lynch
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | | | - Matthew J Budoff
- Division of Cardiology, Harbor-University of California-Los Angeles Medical Center, Los Angeles
| | - Song Shou Mao
- Division of Cardiology, Harbor-University of California-Los Angeles Medical Center, Los Angeles
| | - Debra Dyer
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor.,Pulmonary and Critical Care Medicine, Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Russell P Bowler
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Terri H Beaty
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Elizabeth Kern
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - Stephen Humphries
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | | | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scottland
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham Women's Hospital, Boston, Massachusetts
| | - James D Crapo
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - James H Finigan
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
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An Evaluation of HTML5 and WebGL for Medical Imaging Applications. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:1592821. [PMID: 30245782 PMCID: PMC6136584 DOI: 10.1155/2018/1592821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 11/21/2022]
Abstract
Despite the fact that a large number of web applications are used in the medical community, there are still certain technological challenges that need to be addressed, for example, browser plug-ins and efficient 3D visualization. These problems make it necessary for a specific browser plug-in to be preinstalled on the client side when launching applications. Otherwise, the applications fail to run due to the lack of the required software. This paper presents the latest techniques in hypertext markup language 5 (HTML5) and web graphics library (WebGL) for solving these problems and an evaluation of the suitability of the combination of HTML5 and WebGL for the development of web-based medical imaging applications. In this study, a comprehensive medical imaging application was developed using HTML5 and WebGL. This application connects to the medical image server, runs on a standard personal computer (PC), and is easily accessible via a standard web browser. The several functions required for radiological interpretation were implemented, for example, navigation, magnification, windowing, and fly-through. The HTML5-based medical imaging application was tested on major browsers and different operating systems over a local area network (LAN) and a wide area network (WAN). The experimental results revealed that this application successfully performed two-dimensional (2D) and three-dimensional (3D) functions on different PCs over the LAN and WAN. Moreover, it demonstrated an excellent performance for remote access users, especially over a short time period for 3D visualization and a real-time fly-through navigation. The results of the study demonstrate that HTML5 and WebGL combination is suitable for the development of medical imaging applications. Moreover, the advantages and limitations of these technologies are discussed in this paper.
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Abstract
Since the introduction of CT colonography (CTC) in the mid-1990s, there have been continuous advancements in the examination technique and advanced visualization software for interpretation. This review will cover the origins of CTC as a natural extension of abdominal CT imaging, and discuss the evolution of CTC through the subsequent clinical phases of feasibility, validation, and implementation.
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14
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Manjunath KN, Siddalingaswamy PC, Prabhu GK. Measurement of smaller colon polyp in CT colonography images using morphological image processing. Int J Comput Assist Radiol Surg 2017; 12:1845-1855. [PMID: 28573348 DOI: 10.1007/s11548-017-1615-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Automated measurement of the size and shape of colon polyps is one of the challenges in Computed tomography colonography (CTC). The objective of this retrospective study was to improve the sensitivity and specificity of smaller polyp measurement in CTC using image processing techniques. METHODS A domain knowledge-based method has been implemented with hybrid method of colon segmentation, morphological image processing operators for detecting the colonic structures, and the decision-making system for delineating the smaller polyp-based on a priori knowledge. RESULTS The method was applied on 45 CTC dataset. The key finding was that the smaller polyps were accurately measured. In addition to 6-9 mm range, polyps of even <5 mm were also detected. The results were validated qualitatively and quantitatively using both 2D MPR and 3D view. Implementation was done on a high-performance computer with parallel processing. It takes [Formula: see text] min for measuring the smaller polyp in a dataset of 500 CTC images. With this method, [Formula: see text] and [Formula: see text] were achieved. CONCLUSIONS The domain-based approach with morphological image processing has given good results. The smaller polyps were measured accurately which helps in making right clinical decisions. Qualitatively and quantitatively the results were acceptable when compared to the ground truth at [Formula: see text].
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Affiliation(s)
- K N Manjunath
- Faculty, Computer Science and Engineering, Manipal Institute of Technology, Manipal University, Manipal, 576104, India.
| | - P C Siddalingaswamy
- Faculty, Computer Science and Engineering, Manipal Institute of Technology, Manipal University, Manipal, 576104, India
| | - G K Prabhu
- Faculty, Biomedical Engineering, Manipal Institute of Technology, Manipal University, Manipal, 576104, India
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CT Colonographic Screening of Patients With a Family History of Colorectal Cancer: Comparison With Adults at Average Risk and Implications for Guidelines. AJR Am J Roentgenol 2017; 208:794-800. [PMID: 28125785 DOI: 10.2214/ajr.16.16724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purposes of this study were to compare rates of lesion detection at CT colonographic (CTC) screening of adults without symptoms who had and who did not have a family history of colorectal cancer according to American Cancer Society guidelines and to consider the clinical implications. MATERIALS AND METHODS Over 134 months, consecutively registered CTC cohorts of adults without symptoms who had (n = 156; 88 [56.4%] women; 68 [43.6%] men; mean age, 56.3 years) and who did not have (n = 8857; 4757 [53.7%] women; 4100 [46.3%] men; mean age, 56.6 years) an American Cancer Society-defined family history of colorectal cancer (first-degree relative with diagnosis before age 60 years or two first-degree relatives with diagnosis at any age) were compared for relevant colorectal findings. RESULTS For the family history versus no family history cohorts, the frequency of all nondiminutive polyps (≥ 6 mm) reported at CTC was 23.7% versus 15.5% (p = 0.007); small polyps (6-9 mm), 13.5% versus 9.1% (p = 0.068); and large polyps (≥ 10 mm), 10.2% versus 6.5% (p = 0.068). The rate of referral for colonoscopy was greater for the family history cohort (16.0% vs 10.5%; p = 0.035). However, the frequencies of proven advanced adenoma (4.5% vs 3.2%; p = 0.357), nonadvanced adenoma (5.1% vs 2.6%; p = 0.070), and cancer (0.0% vs 0.4%; p = 0.999) were not significantly increased. The difference in positive rates between the two cohorts (11.5% vs 4.3%; p < 0.001) was primarily due to nonneoplastic findings of no colorectal cancer relevance, such as small hyperplastic polyps, diverticular disease, and false-positive CTC findings. CONCLUSION Although the overall CTC-positive and colonoscopy referral rates were higher in the family history cohort, the clinically relevant frequencies of advanced neoplasia and cancer were not sufficiently increased to preclude CTC screening. These findings support the use of CTC as a front-line screening option in adults with a family history of colorectal cancer.
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16
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Chen LS, Hsu TW, Chen SJ, Chang SH, Lin CW, Chen YR, Hsieh CC, Han SC, Chang KY, Hou CJ. Application of gray level mapping in computed tomographic colonography: a pilot study to compare with traditional surface rendering method for identification and differentiation of endoluminal lesions. Br J Radiol 2016; 90:20160733. [PMID: 27925483 DOI: 10.1259/bjr.20160733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In traditional surface rendering (SR) computed tomographic endoscopy, only the shape of endoluminal lesion is depicted without gray-level information unless the volume rendering technique is used. However, volume rendering technique is relatively slow and complex in terms of computation time and parameter setting. We use computed tomographic colonography (CTC) images as examples and report a new visualization technique by three-dimensional gray level mapping (GM) to better identify and differentiate endoluminal lesions. METHODS There are 33 various endoluminal cases from 30 patients evaluated in this clinical study. These cases were segmented using gray-level threshold. The marching cube algorithm was used to detect isosurfaces in volumetric data sets. GM is applied using the surface gray level of CTC. Radiologists conducted the clinical evaluation of the SR and GM images. The Wilcoxon signed-rank test was used for data analysis. RESULTS Clinical evaluation confirms GM is significantly superior to SR in terms of gray-level pattern and spatial shape presentation of endoluminal cases (p < 0.01) and improves the confidence of identification and clinical classification of endoluminal lesions significantly (p < 0.01). The specificity and diagnostic accuracy of GM is significantly better than those of SR in diagnostic performance evaluation (p < 0.01). CONCLUSION GM can reduce confusion in three-dimensional CTC and well correlate CTC with sectional images by the location as well as gray-level value. Hence, GM increases identification and differentiation of endoluminal lesions, and facilitates diagnostic process. Advances in knowledge: GM significantly improves the traditional SR method by providing reliable gray-level information for the surface points and is helpful in identification and differentiation of endoluminal lesions according to their shape and density.
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Affiliation(s)
- Lih-Shyang Chen
- 3 School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan, ROC.,4 Department of Medical Imaging, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan, ROC
| | - Ta-Wen Hsu
- 2 Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan, ROC.,3 School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan, ROC
| | - Shao-Jer Chen
- 3 School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan, ROC.,4 Department of Medical Imaging, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan, ROC
| | - Shu-Han Chang
- 1 Department of Electric Engineering, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Chih-Wen Lin
- 3 School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan, ROC.,4 Department of Medical Imaging, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan, ROC
| | - Yu-Ruei Chen
- 4 Department of Medical Imaging, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan, ROC
| | - Chin-Chiang Hsieh
- 5 Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
| | - Shu-Chen Han
- 6 Department of Radiology, Tainan Municipal Hospital, Tainan, Taiwan, ROC
| | - Ku-Yaw Chang
- 7 Department of Computer Science and Information Engineering, Da-Yeh University, Changhua, Taiwan, ROC
| | - Chun-Ju Hou
- 8 Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan, ROC
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Pickhardt PJ, Pooler BD, Mbah I, Weiss JM, Kim DH. Colorectal Findings at Repeat CT Colonography Screening after Initial CT Colonography Screening Negative for Polyps Larger than 5 mm. Radiology 2016; 282:139-148. [PMID: 27552558 DOI: 10.1148/radiol.2016160582] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose To determine the rate and types of polyps detected at repeat computed tomographic (CT) colonography screening after initial negative findings at CT colonography screening. Materials and Methods Among 5640 negative CT colonography screenings (no polyps ≥ 6 mm) performed before 2010 at one medical center, 1429 (25.3%; mean age, 61.4 years; 736 women, 693 men) patients have returned for repeat CT colonography screening (mean interval, 5.7 years ± 0.9; range, 4.5-10.7 years). Positive rates and histologic findings of initial and repeat screening were compared in this HIPAA-compliant, institutional review board-approved study. For all patients with positive findings at repeat CT colonography, the findings were directly compared against the initial CT colonography findings. Fisher exact, Pearson χ2, and Student t tests were applied as indicated. Results Repeat CT colonography screening was positive for lesions 6 mm or larger in 173 (12.1%) adults (compared with 14.3% at initial CT colonography screening, P = .29). In the 173 patients, 29.5% (61 of 207) of nondiminutive polyps could be identified as diminutive at the initial CT colonography and 12.6% (26 of 207) were missed. Large polyps, advanced neoplasia (advanced adenomas and cancer), and invasive cancer were seen in 3.8% (55 of 1429), 2.8% (40 of 1429), and 0.14% (two of 1429), respectively, at follow-up, compared with 5.2% (P = .02), 3.2% (P = .52), and 0.45% (P = .17), respectively, at initial screening. Of 42 advanced lesions in 40 follow-up screenings, 33 (78.6%) were right sided and 22 (52.4%) were flat, compared with 45.4% (P < .001) and 11.3% (P < .001), respectively, at initial screening. Large right-sided serrated lesions were confirmed in 20 individuals (1.4%), compared with 0.5% (P < .001) confirmed at initial screening. Conclusion Positive rates for large polyps at repeat CT colonography screening (3.7%) were lower compared with those at initial screening (5.2%). However, more advanced right-sided lesions were detected at follow-up CT colonography, many of which were flat, serrated lesions. The cumulative findings support both the nonreporting of diminutive lesions and a 5-10-year screening interval. © RSNA, 2016 An earlier incorrect version of this article appeared online. This article was corrected on August 30, 2016.
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Affiliation(s)
- Perry J Pickhardt
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - B Dustin Pooler
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - Ifeanyi Mbah
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - Jennifer M Weiss
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
| | - David H Kim
- From the Departments of Radiology (P.J.P., B.D.P., I.M., D.H.K.) and Gastroenterology (J.M.W.), University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53705
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Indeterminate but Likely Unimportant Extracolonic Findings at Screening CT Colonography (C-RADS Category E3): Incidence and Outcomes Data From a Clinical Screening Program. AJR Am J Roentgenol 2016; 207:996-1001. [PMID: 27505184 DOI: 10.2214/ajr.16.16275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the incidence and outcomes of unsuspected indeterminate but likely unimportant extracolonic findings (CT Colonography Reporting and Data System [C-RADS] category E3) at screening CT colonography (CTC). MATERIALS AND METHODS Over 99 months (April 2004 through June 2012), 7952 consecutive adults without symptoms of colorectal cancer (4277 women, 3675 men; mean age ± SD, 56.7 ± 7.3 years) underwent first-time screening CTC. Findings prospectively placed into C-RADS category E3 were retrospectively reviewed, including follow-up (range, 2-10 years) and ultimate clinical outcome. RESULTS Unsuspected C-RADS category E3 extracolonic findings were detected in 9.1% (725/7952) of our patient population. A total of 751 category E3 findings were detected among these 725 patients; 25 patients had multiple findings. Commonly involved organ systems included gynecologic (24.4%, 183/751), genitourinary (20.9%, 157/751), lung (20.6%, 155/751), and gastrointestinal (16.1%, 121/751). Consideration for further imaging, if clinically warranted, was suggested in 83.8% (608/725). Sixty-five patients were lost to follow-up. Conditions requiring treatment or surveillance were ultimately diagnosed in 8.3% (55/660), including eight malignant neoplasms. In the remaining 605 patients, 25 (4.1%) underwent invasive biopsy or surgery to prove benignity (including 18 complex adnexal masses), and 278 (46.0%) received additional imaging follow-up. CONCLUSION Indeterminate but likely unimportant extracolonic findings (C-RADS category E3) occurred in less than 10% of adults without symptoms of colorectal cancer who underwent screening CTC. Over 90% of these findings ultimately proved to be clinically insignificant, with fewer than 5% requiring an invasive procedure to prove benign disease, the majority of which (> 70%) were complex adnexal lesions in women.
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Scalise P, Mantarro A, Pancrazi F, Neri E. Computed tomography colonography for the practicing radiologist: A review of current recommendations on methodology and clinical indications. World J Radiol 2016; 8:472-483. [PMID: 27247713 PMCID: PMC4882404 DOI: 10.4329/wjr.v8.i5.472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/23/2015] [Accepted: 02/24/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) represents one of the most relevant causes of morbidity and mortality in Western societies. CRC screening is actually based on faecal occult blood testing, and optical colonoscopy still remains the gold standard screening test for cancer detection. However, computed tomography colonography (CT colonography) constitutes a reliable, minimally-invasive method to rapidly and effectively evaluate the entire colon for clinically relevant lesions. Furthermore, even if the benefits of its employment in CRC mass screening have not fully established yet, CT colonography may represent a reasonable alternative screening test in patients who cannot undergo or refuse colonoscopy. Therefore, the purpose of our review is to illustrate the most updated recommendations on methodology and the current clinical indications of CT colonography, according to the data of the existing relevant literature.
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Theis J, Kim DH, Lubner MG, Muñoz del Rio A, Pickhardt PJ. CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination. Abdom Radiol (NY) 2016; 41:10-8. [PMID: 26830606 DOI: 10.1007/s00261-015-0595-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To objectively compare the volume, density, and distribution of luminal fluid for same-day oral-contrast-enhanced CTC following incomplete optical colonoscopy (OC) vs. deferred CTC on a separate day utilizing a dedicated CTC bowel preparation. METHODS HIPAA-compliant, IRB-approved retrospective study compared 103 same-day CTC studies after incomplete OC (utilizing 30 mL oral diatrizoate) against 151 CTC examinations performed on a separate day after failed OC using a dedicated CTC bowel preparation (oral magnesium citrate/dilute barium/diatrizoate the evening before). A subgroup of 15 patients who had both same-day CTC and separate-day routine CTC was also identified and underwent separate analysis. CTC exams were analyzed for opacified fluid distribution within the GI tract, as well as density and volume. Data were analyzed utilizing Kruskal-Wallis and Wilcoxon Signed Rank tests. RESULTS Opacified luminal fluid extended to the rectum in 56% (58/103) of same-day CTC vs. 100% (151/151) of deferred separate-day CTC (p < 0.0001). For same-day CTC, contrast failed to reach the colon in 11% (11/103) and failed to reach the left colon in 26% (27/103). Volumetric colonic fluid segmentation for fluid analysis (successful in 80 same-day and 147 separate-day cases) showed significantly more fluid in the same-day cohort (mean, 227 vs. 166 mL; p < 0.0001); the actual difference is underestimated due to excluded cases. Mean colonic fluid attenuation was significantly lower in the same-day cohort (545 vs. 735 HU; p < 0.0001). Similar findings were identified in the smaller cohort with direct intra-patient CTC comparison. CONCLUSIONS Dedicated CTC bowel preparation on a separate day following incomplete OC results in a much higher quality examination compared with same-day CTC.
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Affiliation(s)
- Jake Theis
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Alejandro Muñoz del Rio
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA.
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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Potentially Important Extracolonic Findings at Screening CT Colonography: Incidence and Outcomes Data From a Clinical Screening Program. AJR Am J Roentgenol 2015; 206:313-8. [PMID: 26491809 DOI: 10.2214/ajr.15.15193] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The effect of detection of extracolonic findings at screening CT colonography (CTC) remains controversial. Our objective is to analyze the incidence and outcomes of unsuspected potentially significant (CT Colonography Reporting and Data System [C-RADS] extracolonic category E4) findings in a population undergoing clinical CTC screening. SUBJECTS AND METHODS Over the course of 99 months (April 1, 2004, through June 30, 2012), 7952 consecutive asymptomatic adults (3675 men and 4277 women; mean [± SD] age, 56.7 ± 7.3 years) underwent first-time screening CTC. Examinations were prospectively interpreted by radiologists within our abdominal imaging section, and extracolonic findings were recorded and categorized. Potentially significant (i.e., C-RADS extracolonic category E4) findings were retrospectively reviewed with additional analysis of follow-up (range, 2-10 years) and ultimate clinical outcome. RESULTS Overall, 2.5% (202/7952) of patients had a potentially significant (C-RADS category E4) extracolonic finding for which further imaging (56%; 113/202) or clinical follow-up (44%; 89/202) was recommended. No patients had multiple category E4 findings. Twenty-two patients were lost to follow-up. Of the remaining 180 patients, 68% (123/180) proved to have clinically significant disease, including 23% (42/180) with malignant or potentially malignant neoplasms and 32% (57/180) with abdominal aortic or other visceral artery aneurysms requiring treatment or surveillance. The most commonly involved organs and systems included the vascular system (26%; 53/202), the genitourinary system (18%; 36/202), the liver (15%; 30/202), the gastrointestinal system (9.9%; 20/202), the lungs (9.4%; 19/202), and the gynecologic system (6.9%; 14/202). CONCLUSION Potentially significant extracolonic findings in asymptomatic adults at screening CTC are uncommon (2-3% of cases). However, most of these findings (68%) will prove to be clinically significant, including a number of malignancies and aneurysms requiring treatment or surveillance.
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Lubner MG, Pooler BD, Kitchin DR, Tang J, Li K, Kim DH, Munoz del Rio A, Chen GH, Pickhardt PJ. Sub-milliSievert (sub-mSv) CT colonography: a prospective comparison of image quality and polyp conspicuity at reduced-dose versus standard-dose imaging. Eur Radiol 2015; 25:2089-102. [PMID: 25903700 DOI: 10.1007/s00330-015-3603-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 01/09/2015] [Accepted: 01/15/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To prospectively compare reduced-dose (RD) CT colonography (CTC) with standard-dose (SD) imaging using several reconstruction algorithms. METHODS Following SD supine CTC, 40 patients (mean age, 57.3 years; 17 M/23 F; mean BMI, 27.2) underwent an additional RD supine examination (targeted dose reduction, 70-90%). DLP, CTDI(vol), effective dose, and SSDE were compared. Several reconstruction algorithms were applied to RD series. SD-FBP served as reference standard. Objective image noise, subjective image quality and polyp conspicuity were assessed. RESULTS Mean CTDI(vol) and effective dose for RD series was 0.89 mGy (median 0.65) and 0.6 mSv (median 0.44), compared with 3.8 mGy (median 3.1) and 2.8 mSv (median 2.3) for SD series, respectively. Mean dose reduction was 78%. Mean image noise was significantly reduced on RD-PICCS (24.3 ± 19HU) and RD-MBIR (19 ± 18HU) compared with RD-FBP (90 ± 33), RD-ASIR (72 ± 27) and SD-FBP (47 ± 14 HU). 2D image quality score was higher with RD-PICCS, RD-MBIR, and SD-FBP (2.7 ± 0.4/2.8 ± 0.4/2.9 ± 0.6) compared with RD-FBP (1.5 ± 0.4) and RD-ASIR (1.8 ± 0.44). A similar trend was seen with 3D image quality scores. Polyp conspicuity scores were similar between SD-FBP/RD-PICCS/RD-MBIR (3.5 ± 0.6/3.2 ± 0.8/3.3 ± 0.6). CONCLUSION Sub-milliSievert CTC performed with iterative reconstruction techniques demonstrate decreased image quality compared to SD, but improved image quality compared to RD images reconstructed with FBP. KEY POINTS • CT colonography dose can be substantially lowered using advanced iterative reconstruction techniques. • Iterative reconstruction techniques (MBIR/PICCS) reduce image noise and improve image quality. • The PICCS/MBIR-reconstructed, reduced-dose series shows decreased 2D/3D image quality compared to the standard-dose series. • Polyp conspicuity was similar on standard-dose images compared to reduced-dose images reconstructed with MBIR/PICCS.
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Affiliation(s)
- Meghan G Lubner
- Departments of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792-3252, USA,
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Lips LMJ, Cremers PTJ, Pickhardt PJ, Cremers SEH, Janssen-Heijnen MLG, de Witte MT, Simons PCG. Sigmoid Cancer versus Chronic Diverticular Disease: Differentiating Features at CT Colonography. Radiology 2015; 275:127-35. [DOI: 10.1148/radiol.14132829] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Pickhardt PJ. CT colonography for population screening: ready for prime time? Dig Dis Sci 2015; 60:647-59. [PMID: 25492504 PMCID: PMC4629223 DOI: 10.1007/s10620-014-3454-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA,
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25
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de Haan MC, Pickhardt PJ, Stoker J. CT colonography: accuracy, acceptance, safety and position in organised population screening. Gut 2015; 64:342-50. [PMID: 25468258 DOI: 10.1136/gutjnl-2014-308696] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. The introduction of CRC screening programmes using stool tests and flexible sigmoidoscopy, have been shown to reduce CRC-related mortality substantially. In several European countries, population-based CRC screening programmes are ongoing or being rolled out. Stool tests like faecal occult blood testing are non-invasive and simple to perform, but are primarily designed to detect early invasive cancer. More invasive tests like colonoscopy and CT colonography (CTC) aim at accurately detecting both CRC and cancer precursors, thus providing for cancer prevention. This review focuses on the accuracy, acceptance and safety of CTC as a CRC screening technique and on the current position of CTC in organised population screening. Based on the detection characteristics and acceptability of CTC screening, it might be a viable screening test. The potential disadvantage of radiation exposure is probably overemphasised, especially with newer technology. At this time-point, it is not entirely clear whether the detection of extracolonic findings at CTC is of net benefit and is cost effective, but with responsible handling, this may be the case. Future efforts will seek to further improve the technique, refine appropriate diagnostic algorithms and study cost-effectiveness.
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Affiliation(s)
- Margriet C de Haan
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands Department of Radiology, University Medical Center, Utrecht, The Netherlands
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Jaap Stoker
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Bannas P, Bakke J, Munoz del Rio A, Pickhardt PJ. Intra-individual comparison of magnesium citrate and sodium phosphate for bowel preparation at CT colonography: automated volumetric analysis of residual fluid for quality assessment. Clin Radiol 2014; 69:1171-7. [PMID: 25239789 PMCID: PMC4201391 DOI: 10.1016/j.crad.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 06/30/2014] [Accepted: 08/04/2014] [Indexed: 01/16/2023]
Abstract
AIM To perform an objective, intra-individual comparison of residual colonic fluid volume and attenuation associated with the current front-line laxative magnesium citrate (MgC) versus the former front-line laxative sodium phosphate (NaP) at CT colonography (CTC). MATERIALS AND METHODS This retrospective Health Insurance and Portability and Accountability Act-compliant study had institutional review board approval; informed consent was waived. The study cohort included 250 asymptomatic adults (mean age at index 56.1 years; 124 male/126 female) who underwent CTC screening twice over a 5 year interval. Colon catharsis at initial and follow-up screening employed single-dose NaP and double-dose MgC, respectively, allowing for intra-patient comparison. Automated volumetric analysis of residual colonic fluid volume and attenuation was performed on all 500 CTC studies. Colonic fluid volume <200 ml and mean attenuation between 300-900 HU were considered optimal. Paired t-test and McNemar's test were used to compare differences. RESULTS Residual fluid volumes <200 ml were recorded in 192 examinations (76.8%) following MgC and in 204 examinations (81.6%) following NaP (p = 0.23). The mean total residual fluid volume was 155 ± 114 ml for MgC and 143 ± 100 ml for NaP (p = 0.01). The attenuation range of 300-900 HU was significantly more frequent for MgC (n = 220, 88%) than for NaP (n = 127, 50.8%; p < 0.001). Mean fluid attenuation was significantly lower for MgC (700 ± 165 HU) than for NaP (878 ± 155 HU; p < 0.001). Concomitant presence of both optimal fluid volume and attenuation was significantly more frequent for MgC 65.2% than for NaP (38%; p < 0.001). CONCLUSIONS Objective intra-individual comparison using automated volumetric analysis suggests that the replacement of NaP by MgC as the front-line laxative for CTC has not compromised overall examination quality.
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Affiliation(s)
- P Bannas
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA; Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - J Bakke
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - A Munoz del Rio
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - P J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
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Manjunath KN, Gopalakrishna PK, Siddalingaswamy PC. Feasibility of computed tomography colonography as a diagnostic procedure in colon cancer screening in India. Asian Pac J Cancer Prev 2014; 15:5111-6. [PMID: 25040959 DOI: 10.7314/apjcp.2014.15.13.5111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Computed Tomography Colonography (CTC) is a medical imaging technology used in identifying polyps and colon cancer masses in the large intestine. The technique has evolved a great deal since its invention and has become a routine diagnostic procedure in Western countries due to its non invasiveness and ease of use. The objective of our study was to explore the possibility of CTC application in Indian hospitals. This paper gives an overview of the procedure and its commercial viability. The explanation begins with the domain aspects from gastroenterologist perspective, the new way of thinking in polyp classification, the technical components of CTC procedure, and how engineering solutions have helped clinicians in solving the complexities involved in colon diagnosis. The colon cancer statistics in India and the results of single institution study we carried out with retrospective data is explained. By considering the increasing number of patients developing colon malignancies, the practicality of CTC in Indian hospitals is discussed. This paper does not reveal any technical aspects (algorithms) of engineering solutions implemented in CTC.
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Affiliation(s)
- Kanabagatte Nanjundappa Manjunath
- Department of Biomedical Engineering, Research Scholar, Manipal Institute of Technology, Manipal University, Manipal, India E-mail :
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CT Colonography Reporting and Data System (C-RADS): benchmark values from a clinical screening program. AJR Am J Roentgenol 2014; 202:1232-7. [PMID: 24848819 DOI: 10.2214/ajr.13.11272] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The CT Colonography Reporting and Data System (C-RADS) is a well-recognized standard for reporting findings at CT colonography (CTC). However, few data on benchmark values for clinical performance have been published to date, especially for screening. The purpose of this study was to establish baseline C-RADS values for CTC screening. SUBJECTS AND METHODS From 2005 to 2011, 6769 asymptomatic adults (3110 men and 3659 women) 50-79 years old (mean [± SD] age, 56.7 ± 6.1 years) were enrolled for first-time CTC screening at a single center. CTC results were prospectively classified according to C-RADS for both colorectal and extracolonic findings. C-RADS classification rates and outcomes for positive patients were analyzed. RESULTS C-RADS classification rates for colorectal evaluation were C0 (0.7%), C1 (85.0%), C2 (8.6%), C3 (5.2%), and C4 (0.6%). Overall, 14.3% of subjects were positive (C2-C4), and positive findings were more frequent among men (17.5%) than women (11.6%; p < 0.0001). Positivity also increased with age, from 13.4% of patients 50-64 years old to 21.8% of patients 65-79 years old (p < 0.0001). Regarding extracolonic evaluation, 86.6% of patients were either negative for extracolonic findings or had unimportant extracolonic findings (E1 or E2). Likely unimportant but indeterminate extracolonic findings where further workup might be indicated (E3) were found in 11.3% of patients, whereas 2.1% had likely important extracolonic findings (E4). Overall, E3 and E4 rates were increased for older (p < 0.0001) and female (p = 0.008) cohorts. CONCLUSION C-RADS results from our initial experience with CTC screening may serve as an initial benchmark for program comparison and quality assurance measures.
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Lung P, Burling D, Kallarackel L, Muckian J, Ilangovan R, Gupta A, Marshall M, Shorvon P, Halligan S, Bhatnagar G, Bassett P, Taylor S. Implementation of a new CT colonography service: 5 Year experience. Clin Radiol 2014; 69:597-605. [DOI: 10.1016/j.crad.2014.01.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 01/07/2014] [Accepted: 01/09/2014] [Indexed: 11/25/2022]
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Plumb AA, Halligan S, Nickerson C, Bassett P, Goddard AF, Taylor SA, Patnick J, Burling D. Use of CT colonography in the English Bowel Cancer Screening Programme. Gut 2014; 63:964-73. [PMID: 23955527 PMCID: PMC4033278 DOI: 10.1136/gutjnl-2013-304697] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine use of CT colonography (CTC) in the English Bowel Cancer Screening Programme (BCSP) and investigate detection rates. DESIGN Retrospective analysis of routinely coded BCSP data. Guaiac faecal occult blood test (gFOBt)-positive screenees undergoing CTC from June 2006 to July 2012 as their first-line colonic investigation were included. Abnormalities found at CTC, subsequent polyp, adenoma and cancer detection and positive predictive value (PPV) were calculated. Detection rates were compared with those observed in gFOBt-positive screenees investigated by colonoscopy. Multilevel logistic regression was used to examine factors associated with variable detection. RESULTS 2731 screenees underwent CTC. Colorectal cancer (CRC) or polyps were suspected in 1027 individuals (37.6%; 95% CI 33.8% to 41.4%); 911 of these underwent confirmatory testing. 124 screenees had CRC (4.5%) and 533 had polyps (19.5%), 468 adenomatous (17.1%). Overall detection was 24.1% (95% CI 21.5% to 26.6%) for CRC or polyps and 21.7% (95% CI 19.2% to 24.1%) for CRC or adenoma. Advanced neoplasia was detected in 504 screenees (18.5%; 95% CI 16.1% to 20.8%). PPV for CRC or polyp was 72.1% (95% CI 66.6% to 77.6%). By comparison, 9.0% of 72 817 screenees undergoing colonoscopy had cancer and 50.6% had polyps; advanced neoplasia was detected in 32.7%. CTC detection rates and PPV were higher at centres with experienced radiologists (>1000 examinations) and at high-volume centres (>175 cases/radiologist/annum). Centres using three-dimensional interpretation detected more neoplasia. CONCLUSIONS In the BCSP, detection rates after positive gFOBt are lower for CTC than colonoscopy, although populations undergoing the two tests are different. Centres with more experienced radiologists have higher detection and accuracy. Rigorous quality assurance of BCSP radiology is needed.
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Affiliation(s)
- Andrew A Plumb
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - Paul Bassett
- Research Support Centre, University College London, London, UK
| | | | - Stuart A Taylor
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | | | - David Burling
- Intestinal Imaging Centre, St Mark's Hospital, Harrow, UK
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Pickhardt PJ, Lam VP, Weiss JM, Kennedy GD, Kim DH. Carpet lesions detected at CT colonography: clinical, imaging, and pathologic features. Radiology 2013; 270:435-43. [PMID: 24029647 DOI: 10.1148/radiol.13130812] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe carpet lesions (laterally spreading tumors ≥ 3 cm) detected at computed tomographic (CT) colonography, including their clinical, imaging, and pathologic features. MATERIALS AND METHODS The imaging reports for 9152 consecutive adults undergoing initial CT colonography at a tertiary center were reviewed in this HIPAA-compliant, institutional review board-approved retrospective study to identify all potential carpet lesions detected at CT colonography. Carpet lesions were defined as morphologically flat, laterally spreading tumors 3 cm or larger. For those patients with neoplastic carpet lesions, CT colonography studies were analyzed to determine maximal lesion width and height, oral contrast material coating, segmental location, and computer-aided detection (CAD) findings. Demographic data and details of clinical treatment in these patients were reviewed. RESULTS Eighteen carpet lesions in 18 patients (0.2%; mean age, 67.1 years; eight men, 10 women) were identified and were subsequently confirmed at colonoscopy and pathologic examination among 20 potential flat masses (≥3 cm) prospectively identified at CT colonography (there were two nonneoplastic rectal false-positive findings). No additional neoplastic carpet lesions were found in the cohort undergoing colonoscopy after CT colonography and/or surgery (there were no false-negatives). Mean lesion width was 46.5 mm (range, 30-80 mm); mean lesion height was 7.9 mm (range, 4-14 mm). Surface retention of oral contrast material was noted in all 18 cases. All but two lesions were located in the distal rectosigmoid or proximal right colon. At CAD, 17 (94.4%) lesions were detected (mean, 6.2 CAD marks per lesion). Sixteen lesions (88.9%) demonstrated advanced histologic features, including a villous component (n = 11), high-grade dysplasia (n = 4), and invasive cancer (n = 5). Sixteen patients (88.9%) required surgical treatment for complete excision. CONCLUSION CT colonography can effectively depict carpet lesions. Common features in this series included older patient age, rectal or cecal location, surface coating with oral contrast material, multiple CAD hits, advanced yet typically benign histologic features, and surgical treatment.
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Affiliation(s)
- Perry J Pickhardt
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252
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Abstract
Misinterpretation at CT colonography (CTC) can result in either a colorectal lesion being missed (false-negative) or a false-positive diagnosis. This review will largely focus on potential missed lesions-and ways to avoid such misses. The general causes of false-negative interpretation at CTC can be broadly characterized and grouped into discrete categories related to suboptimal study technique, specific lesion characteristics, anatomic location, and imaging artifacts. Overlapping causes further increase the likelihood of missing a clinically relevant lesion. In the end, if the technical factors of bowel preparation, colonic distention, and robust CTC software are adequately addressed on a consistent basis, and the reader is aware of all the potential pitfalls at CTC, important lesions will seldom be missed.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA.
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Hassan C, Pooler BD, Kim DH, Rinaldi A, Repici A, Pickhardt PJ. Computed tomographic colonography for colorectal cancer screening: risk factors for the detection of advanced neoplasia. Cancer 2013; 119:2549-54. [PMID: 23754679 DOI: 10.1002/cncr.28007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/22/2012] [Accepted: 01/03/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND The objective of this study was to determine whether age, sex, a positive family history of colorectal cancer, and body mass index (BMI) are important predictors of advanced neoplasia in the setting of screening computed tomographic colonography (CTC). METHODS Consecutive patients who were referred for first-time screening CTC from 2004 to 2011 at a single medical center were enrolled. Results at pathology were recorded for all patients who underwent polypectomy. Logistic regression was used to identify significant predictor variables for advanced neoplasia (any adenoma ≥ 10 mm or with villous component, high-grade dysplasia, or adenocarcinoma). Odds ratios (ORs) were used to express associations between the study variables (age, sex, BMI, and a positive family history of colorectal cancer) and advanced neoplasia. RESULTS In total, 7620 patients underwent CTC screening. Of these, 276 patients (3.6%; 95% confidence interval [CI], 3.2%-4.1%) ultimately were diagnosed with advanced neoplasia. At multivariate analysis, age (mean OR per 10-year increase, 1.8; 95% CI, 1.6-2.0) and being a man (OR, 1.7; 95% CI, 1.3-2.2) were independent predictors of advanced neoplasia, whereas BMI and a positive family history of colorectal cancer were not. The number needed to screen to detect 1 case of advanced neoplasia varied from 51 among women aged ≤ 55 years to 10 among men aged >65 years. The number of post-CTC colonoscopies needed to detect 1 case of advanced neoplasia varied from 2 to 4. CONCLUSIONS Age and sex were identified as important independent predictors of advanced neoplasia risk in individuals undergoing screening CTC, whereas BMI and a positive family history of colorectal cancer were not. These results have implications for appropriate patient selection.
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Affiliation(s)
- Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy.
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van Ravesteijn VF, Boellaard TN, van der Paardt MP, Serlie IWO, de Haan MC, Stoker J, van Vliet LJ, Vos FM. Electronic cleansing for 24-h limited bowel preparation CT colonography using principal curvature flow. IEEE Trans Biomed Eng 2013; 60:3036-45. [PMID: 23674411 DOI: 10.1109/tbme.2013.2262046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CT colonography (CTC) is one of the recommended methods for colorectal cancer screening. The subject's preparation is one of the most burdensome aspects of CTC with a cathartic bowel preparation. Tagging of the bowel content with an oral contrast medium facilitates CTC with limited bowel preparation. Unfortunately, such preparations adversely affect the 3-D image quality. Thus far, data acquired after very limited bowel preparation were evaluated with a 2-D reading strategy only. Existing cleansing algorithms do not work sufficiently well to allow a primary 3-D reading strategy. We developed an electronic cleansing algorithm, aimed to realize optimal 3-D image quality for low-dose CTC with 24-h limited bowel preparation. The method employs a principal curvature flow algorithm to remove heterogeneities within poorly tagged fecal residue. In addition, a pattern recognition-based approach is used to prevent polyp-like protrusions on the colon surface from being removed by the method. Two experts independently evaluated 40 CTC cases by means of a primary 2-D approach without involvement of electronic cleansing as well as by a primary 3-D method after electronic cleansing. The data contained four variations of 24-h limited bowel preparation and was based on a low radiation dose scanning protocol. The sensitivity for lesions ≥ 6 mm was significantly higher for the primary 3-D reading strategy (84%) than for the primary 2-D reading strategy (68%) (p = 0.031). The reading time was increased from 5:39 min (2-D) to 7:09 min (3-D) (p = 0.005); the readers' confidence was reduced from 2.3 (2-D) to 2.1 (3-D) ( p = 0.013) on a three-point Likert scale. Polyp conspicuity for cleansed submerged lesions was similar to not submerged lesions (p = 0.06). To our knowledge, this study is the first to describe and clinically validate an electronic cleansing algorithm that facilitates low-dose CTC with 24-h limited bowel preparation.
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Pooler BD, Kim DH, Hassan C, Rinaldi A, Burnside ES, Pickhardt PJ. Variation in diagnostic performance among radiologists at screening CT colonography. Radiology 2013; 268:127-34. [PMID: 23449954 DOI: 10.1148/radiol.13121246] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the variation in diagnostic performance among radiologists at screening computed tomographic (CT) colonography. MATERIALS AND METHODS In this HIPAA-compliant, institutional review board-approved study, 6866 asymptomatic adults underwent first-time CT colonographic screening at a single center between January 2005 and November 2011. Results of examinations were interpreted by one of eight board-certified abdominal radiologists (mean number of CT colonographic studies per reader, 858; range, 131-2202). Findings at CT colonography and subsequent colonoscopy were recorded, and key measures of diagnostic performance, including adenoma and advanced neoplasia detection rate, were compared among the radiologists. RESULTS The overall prevalence of histopathologically confirmed advanced neoplasia was 3.6% and did not differ significantly among radiologists (range, 2.4%-4.4%; P = .067; P = .395 when one outlier was excluded). Overall, 19.5% of polyps detected at CT colonography proved to be advanced neoplasia and did not differ significantly among radiologists (range, 14.4%-23.2%; P = .223). The overall per-polyp endoscopic confirmation rate was 93.5%, ranging from 80.0% to 97.6% among radiologists (P = .585). The overall percentage of nondiagnostic CT colonographic examinations was 0.7% and was consistent among radiologists (range, 0.3%-1.1%; P = .509). CONCLUSION Consistent performance for adenoma and advanced neoplasia detection, as well as other clinically relevant end points, were observed among radiologists at CT colonographic screening.
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Affiliation(s)
- B Dustin Pooler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA
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Miyake M, Iinuma G, Taylor SA, Halligan S, Morimoto T, Ichikawa T, Tomimatsu H, Beddoe G, Sugimura K, Arai Y. Comparative performance of a primary-reader and second-reader paradigm of computer-aided detection for CT colonography in a low-prevalence screening population. Jpn J Radiol 2013; 31:310-9. [DOI: 10.1007/s11604-013-0187-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/29/2013] [Indexed: 11/29/2022]
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Abstract
As with any radiologic imaging test, there are several potential interpretive pitfalls at CT colonography that need to be recognized and handled appropriately. Perhaps the single most important step in learning to avoid most of these diagnostic traps is simply to be aware of their existence. With a little experience, most of these potential pitfalls are easily recognized. This article systematically covers the key pitfalls confronting the radiologist at CT colonography interpretation, primarily dividing them into those related to technique and those related to underlying anatomy. Tips and pointers for how to effectively handle these potential pitfalls are included.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-3252, USA.
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Oh SN, Lee YJ, Kim YS, Jung SE, Rha SE, Shin YR, Byun JY, Choi BG. A feasibility study of unidirectional 240°-angle 3D CT colonography. Clin Imaging 2012; 36:553-8. [PMID: 22920361 DOI: 10.1016/j.clinimag.2012.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 01/04/2012] [Indexed: 11/26/2022]
Abstract
In three-dimensional (3D) CT colonography (CTC), a wider viewing angle provides a larger field of view. The purpose of this study was to investigate the polyp detection rate and time efficiency of unidirectional 240°-angle 3D CTC compared with bidirectional 120°-angle CTC. CTC data sets of 40 patients were reviewed by two readers using the two methods. The unidirectional 240°-angle CTC showed a performance in polyp detection similar to the bidirectional 120°-angle CTC with improved time efficiency.
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Affiliation(s)
- Soon Nam Oh
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Zueco Zueco C, Sobrido Sampedro C, Corroto JD, Rodriguez Fernández P, Fontanillo Fontanillo M. CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice. Eur Radiol 2012; 22:1195-204. [PMID: 22246146 DOI: 10.1007/s00330-011-2367-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/09/2011] [Accepted: 12/11/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the positive predictive value (PPV) for polyps ≥ 6 mm detected at CT colonography (CTC) performed without cathartic preparation, with low-dose iodine faecal tagging regimen and to evaluate patient experience. METHODS 1920 average-risk patients underwent CTC without cathartic preparation. Faecal tagging was performed by diatrizoate meglumine and diatrizoate sodium at a total dose of 60 ml (22.2 g of iodine).The standard interpretation method was primary 3D with 2D problem solving. We calculated per-patient and per-polyp PPV in relation to size and morphology. All colonic segments were evaluated for image quality (faecal tagging, amount of liquid and solid residual faeces and luminal distension). Patients completed a questionnaire before and after CTC to assess preparation and examination experience. RESULTS Per-polyp PPV for detected lesions of ≥ 6 mm, 6-9 mm, ≥ 10 mm and ≥ 30 mm were 94.3%, 93.1%, 94.7% and 98%, respectively. Per-polyp PPV, according to lesion morphology, was 94.6%, 97.3% and 85.1% for sessile, pedunculated and flat polyps, respectively. Per-patient PPV was 92.8%. Preparation without frank cathartics was reported to cause minimal discomfort by 78.9% of patients. CONCLUSION CTC without cathartic preparation and low-dose iodine faecal tagging may yield high PPVs for lesions ≥ 6 mm and is well accepted by patients. KEY POINTS • Computed tomographic colonography (CTC) without cathartic preparation is well accepted by patients • Cathartic-free faecal tagging CTC yields high positive predictive values • CTC without cathartic preparation could improve uptake of colorectal cancer screening.
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Affiliation(s)
- Carmen Zueco Zueco
- Complexo Hospitalario Universitario de Vigo - CHUVI, c/Pizarro 22, 36204 Vigo, Pontevedra, Spain.
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Neri E, Faggioni L, Regge D, Vagli P, Turini F, Cerri F, Picano E, Giusti S, Bartolozzi C. CT Colonography: Role of a second reader CAD paradigm in the initial training of radiologists. Eur J Radiol 2011; 80:303-9. [DOI: 10.1016/j.ejrad.2010.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
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Pagés Llinás M, Darnell Martín A, Ayuso Colella J. CT colonography: What radiologists need to know. RADIOLOGIA 2011. [DOI: 10.1016/j.rxeng.2011.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Biomedical imaging research: a fast-emerging area for interdisciplinary collaboration. Biomed Imaging Interv J 2011; 7:e21. [PMID: 22279498 PMCID: PMC3265193 DOI: 10.2349/biij.7.3.e21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 05/20/2011] [Indexed: 11/17/2022] Open
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Wu XW, Wang WQ, Xu JM, Liu B. Impact of different window settings on colon polyp measurements with CT virtual colonoscopy: a phantom study. Clin Imaging 2011; 35:274-8. [DOI: 10.1016/j.clinimag.2010.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 04/12/2010] [Accepted: 06/01/2010] [Indexed: 10/28/2022]
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Pagés Llinás M, Darnell Martín A, Ayuso Colella JR. [CT colonography: what radiologists need to know]. RADIOLOGIA 2011; 53:315-25. [PMID: 21696795 DOI: 10.1016/j.rx.2011.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/11/2010] [Accepted: 01/20/2011] [Indexed: 02/06/2023]
Abstract
In 2008, CT colonography was approved by the American Cancer Society as a technique for screening for colorectal cancer. This approval should be considered an important step in the recognition of the technique, which although still relatively new is already changing some diagnostic algorithms. This update about CT colonography reports the quality parameters necessary for a CT colonographic study to be diagnostic and reviews the technical innovations and colonic preparation for the study. We provide a brief review of the signs and close with a discussion of the current indications for and controversies about the technique.
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Affiliation(s)
- M Pagés Llinás
- Centro de Diagnóstico por la Imagen, Hospital Clínic de Barcelona, Barcelona, España.
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Boone D, Halligan S, Frost R, Kay C, Laghi A, Lefere P, Neri E, Stoker J, Taylor S. CT colonography: Who attends training? A survey of participants at educational workshops. Clin Radiol 2011; 66:510-6. [DOI: 10.1016/j.crad.2010.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/22/2010] [Accepted: 12/06/2010] [Indexed: 12/29/2022]
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Badiani S, Hernandez ST, Karandikar S, Roy-Choudhury S. CT Colonography to exclude colorectal cancer in symptomatic patients. Eur Radiol 2011; 21:2029-38. [DOI: 10.1007/s00330-011-2151-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/19/2011] [Accepted: 03/23/2011] [Indexed: 12/22/2022]
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Hara AK, Blevins M, Chen MH, Dachman AH, Kuo MD, Menias CO, Siewert B, Cheema JI, Obregon RG, Fidler JL, Zimmerman P, Horton KM, Coakley KJ, Iyer RB, Halvorsen RA, Casola G, Yee J, Herman BA, Johnson CD. ACRIN CT colonography trial: does reader's preference for primary two-dimensional versus primary three-dimensional interpretation affect performance? Radiology 2011; 259:435-41. [PMID: 21364081 PMCID: PMC3079118 DOI: 10.1148/radiol.11100250] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine whether the reader's preference for a primary two-dimensional (2D) or three-dimensional (3D) computed tomographic (CT) colonographic interpretation method affects performance when using each technique. MATERIALS AND METHODS In this institutional review board-approved, HIPAA-compliant study, images from 2531 CT colonographic examinations were interpreted by 15 trained radiologists by using colonoscopy as a reference standard. Through a survey at study start, study end, and 6-month intervals, readers were asked whether their interpretive preference in clinical practice was to perform a primary 2D, primary 3D, or both 2D and 3D interpretation. Readers were randomly assigned a primary interpretation method (2D or 3D) for each CT colonographic examination. Sensitivity and specificity of each method (primary 2D or 3D), for detecting polyps of 10 mm or larger and 6 mm or larger, based on interpretive preference were estimated by using resampling methods. RESULTS Little change was observed in readers' preferences when comparing them at study start and study end, respectively, as follows: primary 2D (eight and seven readers), primary 3D (one and two readers), and both 2D and 3D (six and six readers). Sensitivity and specificity, respectively, for identifying examinations with polyps of 10 mm or larger for readers with a primary 2D preference (n = 1128 examinations) were 0.84 and 0.86, which was not significantly different from 0.84 and 0.83 for readers who preferred 2D and 3D (n = 1025 examinations) or from 0.76 and 0.82 for readers with a primary 3D preference (n = 378 examinations). When performance by using the assigned 2D or 3D method was evaluated on the basis of 2D or 3D preference, there was no difference among those readers by using their preferred versus not preferred method of interpretation. Similarly, no significant difference among readers or preferences was seen when performance was evaluated for detection of polyps of 6 mm or larger. CONCLUSION The reader's preference for interpretive method had no effect on CT colonographic performance.
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Affiliation(s)
- Amy K Hara
- Department of Diagnostic Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA.
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de Haan MC, van Gelder RE, Graser A, Bipat S, Stoker J. Diagnostic value of CT-colonography as compared to colonoscopy in an asymptomatic screening population: a meta-analysis. Eur Radiol 2011; 21:1747-63. [PMID: 21455818 PMCID: PMC3128257 DOI: 10.1007/s00330-011-2104-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 02/01/2011] [Accepted: 02/03/2011] [Indexed: 02/06/2023]
Abstract
Objectives Previous meta-analyses on CT-colonography included both average and high risk individuals, which may overestimate the diagnostic value in screening. A meta-analysis was performed to obtain the value of CT-colonography for screening. Methods A search was performed using PubMed, Embase and Cochrane. Article selection and critical appraisal was done by two reviewers. Inclusion criteria: prospective, randomized trials or cohort studies comparing CT-colonography with colonoscopy (≥50 participants), ≥95% average risk participants ≥50 years. Study characteristics and 2 × 2 contingency Tables were recorded. Sensitivity and specificity estimates were calculated per patient and per polyp (≥6 mm, ≥10 mm), using univariate and bivariate analyses. Results Five of 1,021 studies identified were included, including 4,086 participants (<1% high risk). I2-values showed substantial heterogeneity, especially for 6–9 mm polyps and adenomas: 68.1% vs. 78.6% (sensitivity per patient). Estimated sensitivities for patients with polyps or adenomas ≥ 6 mm were 75.9% and 82.9%, corresponding specificities 94.6% and 91.4%. Estimated sensitivities for patients with polyps or adenomas ≥ 10 mm were 83.3% and 87.9%, corresponding specificities 98.7% and 97.6%. Estimated sensitivities per polyp for advanced adenomas ≥ 6 mm and ≥ 10 mm were 83.9% and 83.8%. Conclusion Compared to colonoscopy, CT-colonography has a high sensitivity for adenomas ≥ 10 mm. For (advanced) adenomas ≥ 6 mm sensitivity is somewhat lower.
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Affiliation(s)
- Margriet C de Haan
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Lubner MG, Pickhardt PJ, Tang J, Chen GH. Reduced image noise at low-dose multidetector CT of the abdomen with prior image constrained compressed sensing algorithm. Radiology 2011; 260:248-56. [PMID: 21436086 DOI: 10.1148/radiol.11101380] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the effect of prior image constrained compressed sensing (PICCS) on noise reduction and image quality at low-dose computed tomography (CT). MATERIALS AND METHODS This HIPAA-compliant institutional review board-approved retrospective study was performed by using DICOM CT colonography data sets obtained in 20 adult patients. Informed consent was waived. Low-dose CT colonography was performed with 64-detector CT by using the standard protocol with mean effective dose per series of 3.06 mSv (range, 1.4-7.7 mSv). PICCS was applied to standard filtered back-projection (FBP) series. For FBP and PICCS series, mean and standard deviation (SD) of attenuation were obtained with 100-mm(2) circular region of interest (ROI) at six sites (240 soft-tissue, colonic gas, and subcutaneous fat measurements). Two abdominal radiologists reviewed two- and three-dimensional CT colonography displays and graded image quality with a five-point scale. Phantom studies were performed to compare spatial resolution and image quality between FBP and PICCS. Mean image noise and image quality scores were calculated and compared for clinical and phantom data sets. Bland-Altman, generalized estimating equation regression model, and Student t tests were used to obtain limits of agreement and to compare noise ratios and subjective image quality. RESULTS Mean SD of attenuation (image noise) for ROIs was 38.0 for FBP and 12.2 for PICCS, corresponding to a noise-reduction factor of 3.1 (P < .001). Average noise reduction was 3.3 for soft tissue, 2.8 for air, and 3.0 for fat attenuation. Attenuation did not substantially change between FBP and PICCS images. Average two-dimensional image quality was 2.45 for FBP and 3.4 for PICCS (P < .001). Average three-dimensional image quality at three sites in the colon was 3.5 for FBP and 3.7 for PICCS (P = .34). Phantom data sets revealed no loss of spatial resolution in a line phantom and reduced noise in a liver tumor phantom when PICCS was compared with FBP. CONCLUSION Application of PICCS to standard FBP low-dose multidetector CT abdominal images results in substantial noise reduction and improved image quality.
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Affiliation(s)
- Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/31 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA.
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Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection--systematic review and meta-analysis. Radiology 2011; 259:393-405. [PMID: 21415247 DOI: 10.1148/radiol.11101887] [Citation(s) in RCA: 288] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis of published studies assessing the sensitivity of both computed tomographic (CT) colonography and optical colonoscopy (OC) for colorectal cancer detection. MATERIALS AND METHODS Analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The primary data source was the results of a detailed PubMed search from 1994 to 2009. Diagnostic studies evaluating CT colonography detection of colorectal cancer were assessed by using predefined inclusion and exclusion criteria, in particular requiring both OC and histologic confirmation of disease. Studies that also included a mechanism to assess true-positive versus false-negative diagnoses at OC (eg, segmental unblinding) were used to calculate OC sensitivity. Assessment and data extraction were performed independently by two authors. Potential bias was ascertained by using Quality Assessment of Diagnostic Accuracy Studies guidelines. Specific CT colonography techniques were cataloged. Forest plots of per-patient sensitivity were produced on the basis of random-effect models. Potential bias across primary studies was assessed by using the I(2) statistic. Original study authors were contacted for data clarification when necessary. RESULTS Forty-nine studies provided data on 11,151 patients with a cumulative colorectal cancer prevalence of 3.6% (414 cancers). The sensitivity of CT colonography for colorectal cancer was 96.1% (398 of 414; 95% confidence interval [CI]: 93.8%, 97.7%). No heterogeneity (I(2) = 0%) was detected. No cancers were missed at CT colonography when both cathartic and tagging agents were combined in the bowel preparation. The sensitivity of OC for colorectal cancer, derived from a subset of 25 studies including 9223 patients, was 94.7% (178 of 188; 95% CI: 90.4%, 97.2%). A moderate degree of heterogeneity (I(2) = 50%) was present. CONCLUSION CT colonography is highly sensitive for colorectal cancer, especially when both cathartic and tagging agents are combined in the bowel preparation. Given the relatively low prevalence of colorectal cancer, primary CT colonography may be more suitable than OC for initial investigation of suspected colorectal cancer, assuming reasonable specificity. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101887/-/DC1.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-3252, USA.
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